D.C. Report: All Eyes on Supreme Court, ICD-10 Remains a Hot Topic

HIT Community Turns Gaze towards Supreme Court for Next Week’s Ruling The health IT community in Washington DC has been busy this week, quizzing each other on the possible ramifications of the Supreme Court case involving twenty-six states over provisions in the Affordable Care Act. Oral arguments began this week, and while the public at large will focus on the ACA’s “Individual Mandate provision” or “shared responsibility requirement,” the ACA includes a number of provisions dependent on, or related to, health IT. Of particular interest is how a repeal could affect the Medicare Shared Savings Program, which created the regulatory guidelines for Accountable Care Organizations, and the CMS Innovation Center, which oversees multiple initiatives ranging from Bundled Payments to Patient Centered Medical Homes. We won’t know anything definitive on how the Court could rule until June, but the media frenzy surrounding this week’s arguments will likely leave you feeling just as expert as those of us inside the Beltway.

WEDI Claims Health Care Industry Not Ready to Implement ICD-10 The ICD-10 debate continues to burn around policy circles in Washington. This week the Workgroup for Electronic Data Interchange (WEDI) sent the results of a surveyto CMS, indicating that “industry is falling behind,” in its conversion from ICD-9 to ICD-10. According to the results of a survey of 2,600 health care providers, health plans and health IT venders conducted by WEDI, about half of the healthcare providers said they do not know when they will complete their impact assessment to prepare for the ICD-10 transition, almost half said they do not know when they will begin external testing of ICD-10 code sets, and about one-third said they expect to begin external testing in 2013. WEDI also found that the majority of health plan respondents plan to begin external testing of ICD-10 code sets in 2013. The survey shows progress by health plan respondents: more than one-third already has completed an impact assessment to prepare for the ICD-10 transition, and a quarter or respondents are less than halfway finished with their impact assessment. Of the health IT vendors surveyed, about half are less than halfway finished with developing products to facilitate the ICD-10 transition. Read WEDI’s survey resultshere.

Health Standards Gurus: Hold Off ICD Conversion to 2015 Also published this week by Health Affairs is an article by five well-known informaticists who argue for a “uniform” delay to 2015. According to a paperauthored by Christopher Chute, Stanley Huff, James Ferguson, James Walker, and John Halamka, “the ICD-10-CM conversion is expensive, arduous, disruptive and of limited direct clinical benefit.” Although the authors acknowledge that groups have spent large sums of money in converting their systems, they believe a two year delay would be the least costly and least resource-intensive way to move forward. This recommendation stems from the growing pervasiveness of SNOMED, and the looming release of ICD-11 in 2016. “[A] uniform approach to a delay based on a single switch-over date that would allow alternative implementation methods, such as that using SNOMED CT,” would minimize unnecessary costs and resources they argue. Without actually advocating for an explicit skip of ICD-10 the authors argue that ICD-11 “is tightly coupled to SNOMED CT,” and that is has the capacity to create “linearizations” from its core of cross-linked disease renderings that could look very much like ICD-10. “This would offer a graceful evolution from ICD-10-CM to a twenty-first-century clinical classification (ICD-11) with intrinsic linkage to SNOMED CT.”

GOP Budget Strikes Familiar Tone Representative Paul Ryan (R-Wis.) released his committee’s 2013 budget proposalthis week with changes that would potentially save $2.5 trillion in healthcare spending. His proposal extensively outlines Medicare reforms, but only glances over Medicaid. Starting in 2023, Ryan’s proposal would reform Medicare into a bid premium support system meaning that seniors would choose between tradition Medicare coverage and a private plan making the plans compete in a new “Medicare Exchange” which would save the government some $205 billion over ten years. Savings from this new Medicare program would go directly back to Medicare rather than go toward new entitlements.

Last year Ryan worked with Democratic Sen. Ron Wyden (D-Ore.) to createthis Medicare framework, but with this year’s changes Wyden says he no longer supports the proposal. Some are saying that the Medicaid block grants (savings of $810 billion) are a deal breaker for many politicians. Observers note that the Medicaid block grants under the new budget proposal would cut Medicaid funding in half by 2013, and several Republicans governors thought Medicaid block grants should be optional rather than mandatory.

The repeal of the healthcare law would supposedly save $1.5 trillion over the next ten years. To create other savings on health programs, Ryan proposed reprioritizing the sequestration process to save $261 billion that would otherwise hit the defense industry.